How to choose a counselor

So you have decided to seek therapy, but now you don’t know how to go about selecting a therapist. Here are a few guidelines that will help make this daunting task easier.

Psychotherapy vs Counseling

You can choose a counselor, or you can choose a psychotherapist. Whereas you may not think the difference is important, it will nevertheless be one of the most important aspects of your relationship with your treatment provider. It also determines the frequency, duration and cost of your treatment (did you often wonder why some therapist were expensive, others had a much lower fee?). The nature of your healing, and the areas of changes in your personality are impacted by your choice between a counselor (and counseling), or psychotherapist (and therapy).

Counseling can be provided by any registered or licensed mental health professional. It embodies a short term advisory/mentoring relationship, and involves helping you resolve your immediate crisis.The process can last from 2 sessions to 12 or 15 sessions. When the presenting problem is resolved, you can discontinue counseling sessions. An example would be a client who needs help with dealing with the grief due to a divorce. A counselor would help the client overcome grief and return to the normalcy of her life. Most times this can be achieved in around 2-4 months (8-15 sessions). The counselor provides help with practical coping strategies and skills training.

Psychotherapy, also called therapy, on the other hand, is a more involved process. It entails going deeper into the psyche, and finding patterns from the past that are causing you to behave a certain way. Most times problems lie in early childhood, and these problems slowly unfold in therapy sessions over a period of time. In the example about the grieving client, psychotherapy would involve attempting an understanding of why the client choses this particular person from among the available set of potential partners and their own role in creating, causing, promoting or enduring negative aspects of the marriage (“why did I stay married to an abusive person for 20 years?” or “why was I compelled to break up ?”). The insight into and the understanding of the rational or irrational behaviors of the past enables us to make informed choices in the future, because if we don’t understand our past, we may end up making the same mistakes again in another relationship. In therapy, the focus is not limited to skills training, but on creating an the understanding of the causes that led to distress.

From the example of divorce related grief, we can see that the two – counseling and psychotherapy – are not the same. Psychotherapy requires significant skills and training in addition to the counseling skills, and is more intense and involved. It changes the client’s way of being in the world, and relating with others. Hence the provider may charge more and/or may require more frequent sessions. Psychotherapy is usually of a longer duration, spanning several months, and requires a tapered termination.

The first step towards choosing a therapist is to decide if you would like to enter a counseling relationship or a psychotherapy relationship – would you like help with crisis management, or would you also like to understand the deeper unconscious drives that caused the problem and make lifestyle changes to make sure you don’t repeat those mistakes?

Whereas all therapists can provide counseling, not all counselors are educated, or skilled or knowledgeable about the process of handling deep rooted issues in psychotherapy.

Finding Therapists

Having already chosen either counseling or psychotherapy, you can talk to someone who has had similar problems as yours, and has benefited from therapy or from counseling. Word of mouth referrals are the best sources to find yourself a competent therapist or a counselor.

You can also find someone on the internet portals like Psychology Today, Network Therapy, Good Therapy. You can also google your requirements (couples counseling in Christchurch, couples therapy in Christchurch, marriage counseling in Christchurch individual therapy in clovis, anxiety therapy in Christchurch etc.) and choose someone whose orientation and areas of specialization appeals to you.

I recommend shortlisting at least three professionals and asking them detailed questions about their degrees, their knowledge, their experience and comfort level dealing with your kind of problems. This is true of counseling as well, but especially true if you want to work on deeper issues, and are seeking psychotherapy. You should be comfortable with the provider’s orientation, his or her skills, experience and knowledgebase. Also very important is the relational aspect – healing in psychotherapy comes from the nature of the relationship between you and your therapist. If you are not comfortable in your relationship with your therapist, you must bring it to his or her attention, and explore the reasons. If you still feel uncomfortable, you should ask for a referral.

Always remember : A therapeutic relationship never includes sex, or sexual inuendoes.

Effectiveness of the therapist/counselor

Here on, we will use the term therapist and counselor interchangeably.
There are many levels of practicing professionals. Analysts usually sit at the apex of the hierarchy. They have had intense and specialized training in their field of interest. Psychologists, with a PhD degree, follow behind. Licensed Clinical Social Workers require Master’s level training and claim a more well rounded approach to counseling and therapy than Marriage and Family Therapists who usually graduate from a Marriage and Family Therapy Master’s program with a narrower but deeper focus on relationships. Then at each level of professional license, there are interns, who are in the process of training to acquire that particular license.

If this hasn’t confused you by now, then you’re doing well. A good way to conceptualize this is to understand that when you need a neurologist, you cannot go to a PCP internist, and you certainly cannot go to a cardiologist. Similarly, when you require a MFT, going to a psychologist may not be very helpful, and vice versa. Hence it is important to figure out the nature of your problem so that you can find a specialist, and ask specific questions around your issues.
As for degrees, certifications, and accolades, they mean little if you do not feel comfortable with the professional you are seeing. Although degrees and experience may provide an indication of competence, just because someone has a degree does not mean they are competent, skilled and/or knowledgeable. Although years in practice is often an indicator of a therapist’s competence level, it does not necessarily make them competent.

Whereas a reasonable fee is indicative of expertise, some professionals provide first session free, others charge an extra 20% for the first session. Neither policy is indicative of professional competence. To my knowledge, the normal fee in Christchurch and neighboring areas falls between $30 – $180 per 50 minute sessions, with $80 – $120 being a normative average. Session fee of $180 neither indicates a therapists competence, nor makes a therapist exploitative. By the same token, a fee structure of $75 per session does not necessarily indicate that the professional is reasonable and considerate, nor does it mean that the professional is less skilled and knowledgeable than someone who charges $180 per session. In fact, a variety of factors contribute to setting up of the fee schedule, and these can be discussed with your therapist. In addition to the basic difference in counseling vs psychotherapy (counselors generally have lower rates than psychotherapists), some therapists are more effective, and may end up saving you a lot over longer duration even if their per session rates are higher. Other therapist may like to spread their fee over a longer duration. Some may be weathering a tough economic storm and may not mind lowering fee in the interim. For others, the low fee may be their policy. Some therapists offer a sliding scale depending on your income and expenses. So fee structure may or may not be indicative of the effectiveness of your therapist. It is upto you to find that out. It always helps to remember that the cheapest is not always the best so don’t base your choice of counselor on the amount of money that is being charged.

Therapeutic relationship is a dance that needs a partner that is attuned and empathic to your needs. As mentioned above, the nature of relationship – counseling vs psychotherapy – determines the duration of therapy, the frequency of therapy and the fee structure. Usually all professionals will require a counsultation session during which these issues can be explored and agreed upon.

Theoretical Orientation

The underlying theories used by the therapist to understand and conceptualize your problem defines your therapist’s orientation. Counselors are generally trained in Behavioral Therapy (BT) or Cognitive Behavioral Therapy (CBT) – which involves changing behaviors, and making changes about how you perceive things. You will learn to use rational, logical ways of thinking, and will hopefully be able to manage crisis better.
Some psychotherapists use CBT approaches, others others use psychodynamic techniques. This involves understanding the ongoing relational dynamics in every session in terms of childhood relationships with early caregivers. Psychodynamic techniques are often used in conjunction with theories of Depth Psychology – which includes Psychoanalysis, Object Relations theories, Self Psychology and Jungian Psychology. These all deal with deep, unconscious psyche, hence the term Depth Psychology.

Although you are not expected to understand or know these, you must understand that the therapist’s orientation will determine your treatment, and the outcome of therapy. For example, in a nutshell, psychoanalysis aims at creating insight about your innate and unconscious drives, object relations aims at creating a deep understanding of your relationships and how they impact your present behaviors, Self Psychology attempts to heal you through your relationship with your therapist, and Jungian psychology is a spiritually oriented psychotherapy that, in addition to other objectives, also involves an understanding of how our culture, heritage, mythology, nature and cosmos affect us on a day to day basis.

The orientation you choose to work in, will govern the treatment goals, and the outcome of therapy. You must either research the above orientations, and choose a therapist with the orientation you feel comfortable with. Or alternately, you may ask your therapist to explain his orientation to you.

Unprofessional, Unethical Behaviors

Therapeutic relationship is a very sacred relationship and your therapist is responsible for maintaining the confidentiality, sanctity, and therapeutic effeciveness of the relationship. Whereas you are generally expected to follow the guidelines and the framework set by your therapist, the responsibility of maintaining and enforcing those standards lies with your therapist. If you have any unprofessional or unethical experiences, you must immediately bring it to his or her attention. If you feel concerned, threatened, compromised or abused, you may seek confidential counsel by calling your therapist’s licensing body that sets the Code of Conduct for acceptable professional behavior.

Always remember : Psychotherapy and counseling never involves any kind of sex (emotional, physical or verbal), sexual references, sexual inuendoes. It never involves touching, caressing, or massaging etc.
~
I hope you find the above meaningful, and helpful. I wish you all the best in your search. May it become a fulfilling journey, allowing you to hold the rainbows you were meant to touch.

For further questions on any of the above, email me at madhu.bambroo@gmail.com

3 responses to “How to choose a counselor”

  1. I appreciate your comments.

    M.

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  3. This could be one of the most compelling discussions I ever encountered in a long time, I’m uttering about this section of your article “… and how they impact your present behaviors, Self Psychology attempts to heal you through your relationship with …” this is it, you just crushed it down pal.

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